Ultrasound a sessment of the fetal foramen ovale

Objectives Based on the assumption that the horizontal area between the fetal foramen ovale valve and the atrial septum (the outlet) represents the limiting structure for the foremen ovale flow, our objective teas to determine the normal size of this section during the second half of pregnancy. Methods One hundred and thirty-eight women with low-risk singleton pregnancies were examined in a cross-sectional study between 18 and 42 weeks of gestation. Using ultrasound imaging and M-mode, the area and diameter between the foramen ovale value and the atrial septum were determined in a four-chamber view of the fetal heart above the foramen ovale limbus. The inferior vena cava cross section and right atrial width were also determined. Results The mean foramen ovale width increased from 3 mm at 18 weeks to 6 mm at term. Correspondingly, the horizontal area grew from 15 to 50 mm(2). The mean ratio between this area and the area of the inferior vena cava fell from 1 at 18 weeks to 0.5 at term. The ratio between the transverse width of the foramen ovale and the right atrium remained at average 0.45-0.50 until 32 weeks, when a slight reduction was observed towards term. Conclusions Normal values for the horizontal cross section and transverse diameter of the foramen ovale outlet were established for the second hal of pregnancy. In particular, the horizontal transverse diameter and its ratio to the right atrial width are easy to determine, and use of these measurements is thus suggested for the assessment of the fetal foremen ovale.